Continuing care retirement communities(CCRCs) and fee-for-service continuing care retirement communities(FFSCCRCs) are residential alternatives for adults that offer, under one contract, an independent living unit (an apartment or cottage), residential amenities and access to a continuum of long term care services, as residents' health and social needs change over time. Residential and health care services include:

Supportive housing and services provided in an adult home, an enriched housing setting, or an assisted living residence (FFSCCRCs must provide residents with access to this intermediate level of care; while CCRCs generally provide access to this service, it is not required under the CCRC statute);

Skilled nursing facility (nursing home) care for residents who become temporarily ill or who require long-term care. Skilled nursing care may be provided in an on-site facility or in an off-site nursing home affiliated with the CCRC/FFSCCRC.

Continuing Care Retirement Communities Council Meetings

Becoming a Resident

In general, residents of CCRCs and FFSCCRCs must be at least 62 years of age and must meet both the financial and health criteria established by the CCRC/FFSCCRC. These criteria can vary from community to community but prospective residents must meet the community's health standard, be capable of living independently, and must have sufficient financial resources available to cover the entrance and monthly fees and any additional living expenses.

Prospective CCRC residents must be enrolled in Medicare Part A and Part B and must enroll in and maintain a Medicare Supplemental Insurance policy.

Cost & Payment

Residence in a CCRC/FFSCCRC requires a significant financial commitment. Cost is based on a variety of factors including community location, size of the apartment or cottage chosen, and type of resident contract signed.

Payments to a CCRC/FFSCCRC consist of two components: an entrance fee (generally comparable to the average value of residential homes in the community's geographic area); and, a monthly fee. Entrance fees begin at approximately $115,000 for a single person independent living unit. Monthly fees begin at approximately $2,100.

Contracts

CCRCs may offer two basic types of contracts: life care (Type A) contracts; and, modified (Type B) contracts. The primary difference is the amount of skilled nursing facility care received, without a change in the monthly fee, under each contract type.

Life Care Contracts (Type A)

Life care contracts include unlimited enriched housing/assisted living care (if offered by the community) and unlimited skilled nursing facility services, along with independent housing and residential services and amenities. The resident's monthly fee cannot change due to a change in the level of covered health care required by the resident (except for normal operating costs and inflation adjustment). This means that the resident pays the same monthly fee in the skilled nursing facility as he or she paid in independent housing.

Modified Contracts (Type B)

Modified contracts include independent housing and residential services, but include only a limited number of skilled nursing facility days. The number of skilled nursing facility days covered in a modified contract may vary, but the contract must include at least 60 days of skilled nursing facility coverage, exclusive of Medicare days. As in the life care contract, the resident's monthly fee cannot change due to a change in the level of covered health care required during the skilled nursing facility benefit period included under the contract. Modified contracts may also include an enriched housing/assisted living benefit (if this service is offered by the community). If included in the contract, the resident's monthly fee cannot change due to a need for enriched housing/assisted living services during this covered benefit period. When the contracted health care facility days have been exhausted, the resident must then pay a market or per diem rate if additional skilled nursing care days (or enriched housing/assisted living days) are needed.

Fee for Service Contracts

FFSCCRCs offer fee-for-service continuing care contracts. Fee-for-service contracts include independent housing, residential amenities such as scheduled transportation and social activities, and access to a continuum of long term care services. The long term care services, enriched housing/assisted living and skilled nursing facility care, are available on a fee for service or per diem basis. There is no long-term care benefit included in the contract; the resident pays for long-term care if and when needed.

Entrance Fee Refunds

Continuing care retirement communities and fee-for-service continuing care retirement communities may offer contracts with a variety of entrance fee refund options. The community decides what contract options to offer prospective residents. At a minimum, all resident contracts must provide a refund of some portion of the entrance fee during the first four years of residency. This option is called the traditional declining contract. Under the traditional declining contract, the resident's entrance fee refund is reduced by 2% per month with a one time 4% processing fee. After 48 months of residency, the entrance fee refund is reduced to zero.

Many CCRCs/FFSCCRCs offer contracts which refund a specific percentage of the entrance fee regardless of the length of residency (for example, 90% or 50% refundable contracts are currently offered in several communities). The refund is paid to the resident or the resident's estate if the contract is terminated or on resident death.

Keeping Facilities Operational

While there are no absolute guarantees, the New York State Department of Health has oversight responsibility for the certification and operation of both continuing care retirement communities and fee-for-service continuing care retirement communities.

Department of Health approval is required prior to any marketing of a proposed community. The Department reviews the character and competence of the sponsor, and monitors the programmatic and legal requirements for the CCRC/FFSCCRC, including all organizational documents and resident contracts;

Construction of a CCRC cannot begin until at least 50% of the units have been pre-sold; occupancy of FFSCCRC housing or other facilities cannot begin until at least 50% of the residential units have been pre-sold;

Any changes in the CCRC/FFSCCRC that may affect residents, such as a change in the services offered by the community or a change in the community's operator, require Department of Health approval;

The financial feasibility of a proposed FFSCCRC is reviewed by the Department of Health;

CCRC/FFSCCRCs based on an equity or cooperative model are also reviewed and monitored by the New York State Office of the Attorney General.

Because CCRC resident contracts include a health care guarantee, the New York State Department of Insurance plays a major role in the approval and on-going oversight of these communities.

The Insurance Department must review and approve the proposed Disclosure Statement and Residency Agreement;

The Insurance Department evaluates the financial feasibility of the proposed CCRC;

The Departments of Health and Insurance conduct joint periodic operational and financial reviews of the CCRC.

Finding a community in your area

Currently, there are twelve (12) continuing care retirement communities and one (1) fee-for-service continuing care retirement community that have received a Certificate of Authority from the Commissioner of Health. 12 of these communities are open and are accepting residents. One(1) has a conditional certificate of authority to enter into contracts for a community to be constructed at a future date. DOH has also approved one (1) sponsor to take priority reservations deposits for a community that will require CCRC Council approval to obtain a conditional certificate of authority.

If you have any questions regarding CCRCs and FFSCCRCs, please contact the New York State Department of Health, at (518) 402-0964 or write to:

CCRC Programs
Center for Health Care Facility Planning, Licensure and Finance
New York State Department of Health
Room 1805, Corning Tower ESP
Albany, New York 12237

Conditional Certificate of Authority (COA): The sponsor may enter into contracts with a prospective resident to collect a 10% entrance fee deposit on a to-be-built CCRC. The sponsor must obtain DOH approval prior to construction.